Abstract
Robotic-assisted laparoscopic radical prostatectomy (RARP) needs a steep Trendelenburg position and a relatively high CO2 insufflation pressure, and patients undergoing RARP are usually elderly. These factors make intraoperative ventilatory care difficult and increase the risk of perioperative pulmonary complications. The aim was to determine the efficacy of recruitment manoeuvre (RM) on perioperative pulmonary complications in elderly patients undergoing RARP. A total of 60 elderly patients scheduled for elective RARP were randomly allocated to two groups after induction of anaesthesia; positive end expiratory pressure (PEEP) was applied during the operation without RM in the control group (group C) and after RM in the recruitment group (group R). The total number of patients who developed intraoperative desaturation or postoperative atelectasis was significantly higher in group C compared to group R (43.3% vs. 17.8%, P = 0.034). Intraoperative respiratory mechanics, perioperative blood gas analysis, and pulmonary function testing did not show differences between the groups. Adding RM to PEEP compared to PEEP alone significantly reduced perioperative pulmonary complications in elderly patients undergoing RARP.
Highlights
Robotic-assisted laparoscopic radical prostatectomy (RARP) has attracted increasing attention because it has lower rates of complications and improves the surgical outcome compared to open radical prostatectomy [1, 2]
After obtaining written informed consent, we enrolled patients aged 60–80 years with American Society of Anaesthesiology physical status 1 or 2, who were scheduled for RARP under general anaesthesia from November 4th 2013 to December 29th 2014
The concentrations of propofol and remifentanil were adjusted with target-controlled infusions (TCI) to maintain a bispectral index (BIS) of 40–60 and the mean arterial pressure and heart rate within 20% of pre-induction values during the maintenance of anaesthesia
Summary
Robotic-assisted laparoscopic radical prostatectomy (RARP) has attracted increasing attention because it has lower rates of complications and improves the surgical outcome compared to open radical prostatectomy [1, 2]. In terms of anaesthetic management, RARP reduces blood loss, lowers the rate of transfusion, and shortens the hospitalisation period in comparison to conventional prostatectomy [3].
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